Contact Lens Patient

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					Contact Lens Patient Information___________________________________________

We appreciate your choice of our office for your contact lens needs. Contact lens wear
can improve the quality of your life. However, you must take proper care of your lenses
and know what to do in the event of a problem. This information sheet provides
important instructions and information. Please read it completely and keep it handy to
refer to if you have any questions.

Emergency information
Call our office for assistance if you experience any of the following:
    Eye pain
    Sensitivity to light
    Redness of your eye
    Excessive tearing or discharge
    Cloudy, foggy or reduced vision
In and emergency we can be reached at 319-754-2020

Periodic examinations are a necessary part of maintaining an appropriate and safe contact
lens fit. You should return for all scheduled visits as recommended by your Doctor.

Lens Wear Scheduled and Replacement Information
Contact lenses are medical devices that are regulated by the U.S. Food and Drug
Administration and may additionally be subject to state law requirements. Maintaining
healthy eyes and proper vision includes regular periodic examinations by an eye care
professional. As with prescription medications, contact lenses can only be dispensed
pursuant to a prescription of an eye care practitioner.

To ensure proper adaptation of your contact lenses, this office recommends that you wear
your lenses for 2-4 hours the first day, then add 1-2 hours per day. It is important that
your eyes adapt slowly. Do not wear lenses longer than they feel comfortable in your
eyes. Routine replacement of lenses will result in better vision, more comfortable wear
and healthier eyes. Over wearing of your contact lenses may expose you to additional
Your lenses are designed to be worn on the following schedule:
     Daily wear-up to ____hours, with removal before sleeping
     Continuous wear- up to ___ nights
Your lenses are designed to be replaced on the following basis:
     Daily
     Weekly
     Bi- Monthly
     Monthly
     Quarterly
     Every 6 Months
Lens Care
To a large extent, contact lens wear success will depend on carefully following the care
instructions we give you. Cleanliness is a must. Soft lenses contain a high percentage of
water and can absorb liquids carrying bacteria that might cause eye infections. Wash you
hands before handling your lenses. Avoid highly perfumed or deodorant soaps as they
might irritate you eyes if not well rinsed. Keep your case and solution bottles
scrupulously clean. To avoid mixing up lenses, only handle one lens at a time. Never take
both lids off your case at the same time.

   Always use plenty of solution while handling the lenses as they can dry out in a few
 Use your rewetting drops before removal. If a lens should stick together while
   handling, use plenty of multipurpose solution and massage the lens gently until it
   comes apart. It will tear if pulled forcefully. If you have time, let the lens soak for a
   while before attempting separation.
 If the solution should leak or evaporate from the case and lenses appear to be dry, do
   not touch them. Fill the case with solution and allow the lenses to soak for several
   hours before handling.
 Soft contact lenses are durable if kept wet. The drier the lens is, the more susceptible
   it is to tearing and cracking.
 Small cracks may not be visible, but may worsen as you wear you lenses causing the
   lens to split in the eye. Usually a cracked or chipped lens becomes uncomfortable and
   may scratch your cornea. Any defects in a new lens will be noticeable in the first few
   hours of wear.
To best meet your needs the Doctor recommends the following lens care products:
Solution:____________________ Rewetting Drops:_______________________
Contact Lens Cleaner:___________________ Other:______________________

Do’s and Don’ts
 Do not swim with your contact lenses
 Do not wear cracked or chipped lenses
 Be careful around hairsprays, spray deodorants, and cleaners
 Do not wear lenses around strong fumes
 Never use tap water on soft lenses
 Old lenses must be discarded due to the risk of contamination and infection
 Never let someone else wear your lenses
Lens Insertion
 Take the lid off your case, swirl, and then spill the contact lens into the palm of your
  hand. This will prevent the lens from sticking to the case and prevent gouging.
 Rinse lens under a steady stream of multipurpose solution.
 Inspect lens for deposits, chips, or tears. Do not wear lenses unless they are in perfect
 Place lens on the first finger of your right hand, reach over your head with you left
  hand and tightly grasp the upper lid. Press down on the lower lid with the middle
  finger of your right hand. Look down, side to side, and release the lower lid, then the
  upper lid.
 Repeat steps 1-4

Removal and cleaning
 Before removal, wet the contact lens with 1 to 2 rewetting drops.
 Half fill one side of you case with multipurpose solution
 With two fingers gently grasp the lower edge of the lens and remove.
 Rinse thoroughly, and place the curved side of lens down in the case.
 Finish filling with solution, this will sink the lens to the bottom. If you are not sure
  the lens in on the bottom, gently tap the case on a solid surface before putting on the
  lid. Never put the lids on a case if the lens is floating, the lens will be ruined if caught
  in the lid.

 Ongoing care
Professional care does not end with dispensing of your final lenses. On going success
requires ongoing care. In order to maximize success your Doctor recommends the
 A periodic contact lens and eye health exam every 12 months
 Use of UV sun wear for all outdoor activities
 An updated pair of eyeglasses
 Please remember your contact lens prescription does expire in 12 months

Important: Contact lens patients should not neglect to have eyeglasses with their
current prescription for emergency use. If an eye infection or corneal problem
occurs, contact lens wear may be temporarily discontinued. In order to be able to
function visually at all times, back-up eyeglasses are necessary.

Additional pointers
 Use only water soluble makeup. Put contacts on before apply makeup
 Remove your contacts before removing your makeup
 When in a strong wind, wear sunglasses to prevent you lenses from drying out
 Sunglasses will be needed to reduce sensitivity to light and glare
Contact lens prescription
Successful contact lens wear requires a several week period of adaptation and
observation. You may purchase replacement lenses from anyone you choose during the
life of your prescription. In considering the decision we would like to emphasize our
contact lenses are competitively priced with alternative suppliers. In most cases, your
year’s supply of lenses will be less expensive from our office than another supplier.


I have read this document carefully, and fully understand the importance of the Doctor’s

I have been trained in the care and handling of my contact lenses.

I understand the importance of following all directions, caring for my lenses as
instructed, and returning for all recommended, periodic evaluations and examinations.

I have bee given the opportunity to have all my questions answered and concerns

____________________________________                        ______________
Patient signature                                            Date

___________________________________________            _______________________
Parent signature if minor                                Tech Initials

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